Irritable bowel syndrome (IBS) and elimination diets

Foods Can Cause Symptoms of Irritable Bowel Syndrome (IBS): In the United States, most doctors have been and continue to be skeptical that foods cause symptoms of (IBS) and the elimination of specific foods can improve these symptoms. Nonetheless, nearly 70% of people diagnosed with IBS report symptoms related to specific foods. There is accumulated evidence, although still criticized because of the limitations of the studies that make it difficult to prove, that specific foods can be the cause of the symptoms in many people labeled with IBS.

Food intolerance tests and the elimination diet based on IgG antibodies can be useful: Atkinson (Gut, 2004) randomized people to an elimination diet based on high levels of IgG antibodies (YorkTest Laboratories) for specific foods or a false diet. Those who avoided specific foods based on IgG antibody tests showed an improvement in IBS symptoms (10-26% reduction) and a significantly improved overall quality of life assessment. The reintroduction of foods for which they tested positive led to a deterioration. Zar (Am J Gastro, 2005) reported a significant improvement in IBS symptoms such as pain, swelling and changes in intestinal habits based on the elimination of six months of high food-specific IgG4 antibodies in 25 people.

Irritable bowel syndrome (IBS) is very commonly diagnosed in adults: no diagnostic test can confirm IBS. It is a diagnosis of exclusion. It is a syndrome, that is, a collection of symptoms that cannot be explained by other diseases that lead to the diagnosis of IBS. Common missed diagnoses that are attributed to IBS include lactose intolerance, celiac disease, gluten sensitivity or gluten intolerance, colitis, Crohn’s disease, parasite infections such as giardia, bacterial overgrowth in the intestine or changes in levels and types of intestinal bacteria (dysbiosis), food allergies, food intolerance and food hypersensitivity.

Celiac disease, colitis and Crohn’s disease must be excluded before the diagnosis of IBS: celiac disease, colitis and Crohn’s disease can be diagnosed or excluded from blood tests, stool tests and biopsies of the intestine. Food allergy, intolerance and sensitivity are not only more difficult to confirm or rule out, but often lack due to the limitations of blood tests, feces, skin allergies and biopsies. Adverse food reactions should be considered as a potential cause of the symptoms attributed to IBS.

There are common foods that cause adverse food reactions: common foods reported by IBS patients, whose symptoms improve with elimination, are wheat, barley and rye (gluten); dairy products including cow’s milk protein (casein) and / or lactose (milk sugar); legumes (peanuts) and soybeans; yeast used for cooking or preparing food; Corn; shellfish and fish; walnuts (almond, Brazilian walnut, cashews and walnuts); fruit (apple, orange and strawberry); vegetables (celery, cabbage and lettuce); meats (pork, beef and chicken); and belladonna (potato and tomato).

Individual and specific diets for food elimination are based on a variety of tests and a dietary diary of food symptoms: elimination diets based on common foods that cause allergic reactions and allergic reactions to foods have been used for a some time and are often prescribed with or without a dietary diary of food symptoms. Interestingly, as far as I know, no one has examined the individual approach to these people and their adverse food reactions, based on tests for celiac disease, gluten intolerance or sensitivity (elevated IgA or IgG gliadin antibodies in the blood and / or IgA antibody stool gliadin without blood test diagnostic or biopsy for celiacs), casein intolerance (anti-casein IgA antibody in stool or IgG antibody in the blood), history of oral allergic syndrome (OAS) and in-depth tests on food allergy ( skin prick test, IgE RAST or CAP RAST test, intradermal skin tests or patch skin tests).

Specific dietary tests for the elimination of food based on this information (see table a ) has been helpful in my experience. The cross-reaction between pollen and food in the OAS is well documented. A diet symptom diary combined with specific food elimination based on the results of food allergy tests, food intolerance to food sensitivity tests and known pollen allergies should be considered as a possible approach to the elimination diet. This should not exclude the evaluation and treatment of established celiac disease, lactose intolerance, dysbiosis, colitis or Crohn’s disease.


Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial. Gut 2004; 53: 1459-1464.

Choung RS, Talley NJ. Food allergy and IBS intolerance. Gastroenterology and hepatology October 2006; 2 (10): 757-760.

Zar S, Benson MJ, Kumar D. Serum specific IgG4 and IgE titers for foods for common food antigens in irritable bowel syndrome. American Journal Gastroenterology 2005; 100: 1550-1557.

Zar S, Mincher L, Benson MJ, Kumar D. The exclusion diet guided by food-specific IgG4 antibodies improves symptoms and rectal compliance in irritable bowel syndrome. Scandinavian journal of gastroenterology. 2005; 40: 800-807.

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